U.N. Tells World to Report Outbreaks

By Betsy McKay

Starting Friday, governments around the world will be legally required to report to the World Health Organization disease outbreaks and other serious public health emergencies.

The WHO, the health arm of the United Nations, hopes this stepped-up set of International Health Regulations could help it avert the global spread of nasty germs and bugs, such as avian flu or SARS, as international trade and travel grow.

The requirements represent a significant expansion beyond those on the books since 1969. Those rules required countries to report outbreaks of only four diseases: cholera, plague, yellow fever, and smallpox. Now, government health officials must quickly report outbreaks of emerging infections, not to mention chemical spills, nuclear melt-downs, food contamination, and other incidents that could harm people outside their borders.

Are these new regulations alone enough to thwart a global flu pandemic? It’s not clear. Some governments may not want to reveal health dangers they discover, and WHO can’t compel countries to comply. And while the rules require governments to strengthen disease surveillance, many of the countries that harbor some of the biggest potential public health threats don’t have the money or resources to detect and report those threats early.

Beyond reporting requirements, the WHO’s new rules don’t fully resolve some thorny controversies — such as what obligations countries like Indonesia have to make avian flu virus samples available to researchers outside their borders. Nor do they specify at what point a single case of extensively drug-resistant tuberculosis (XDR-TB), such as that of Atlanta lawyer Andrew Speaker, constitutes an international health threat.

Still, the WHO’s moves are likely to enhance global public health security, says David Fidler, an expert on international law and public health at the Indiana University School of Law. They give WHO the right to use nongovernmental sources — such as media reports, postings on the Internet, or text messages — to confront a national government and start probing an outbreak. The WHO has become increasingly active in monitoring such sources in recent years after first learning about SARS and other outbreaks from them.

Under the new rules, the WHO director-general also has the right to declare an international public health emergency over the objections of a government if necessary, Fidler says. “That’s an amazing power that you rarely see given to international organizations,” he says.